JP4953282B2 - Ophthalmic surgery support device - Google Patents

Description

  The present invention relates to an ophthalmic surgery support apparatus that positions a distal end of a surgical instrument in a fine part such as a fundus and assists an operator to operate the surgical instrument.

For ophthalmic surgery, position the tip of a cannula, which is a surgical instrument, in the thrombus of a fundus blood vessel with a diameter of 0.1-0.2 mm in the retina of the fundus, or puncture the tip of a surgical instrument such as a forceps, scissors, or scissors There is an operation in which the eye is positioned and treated in a minute affected part of the fundus retina. Usually, the surgeon inserts the tip of the surgical instrument through a wound hole formed in the sclera of the eyeball, and performs treatment by positioning the tip of the surgical instrument at the affected part while observing the affected part with a microscope or the like. As an assist device for positioning a cannula in an affected area in the eye, there is one proposed in the following publication.
JP-T-2005-501666

  By the way, in the operation of positioning the tip of the surgical instrument on a fine affected part such as the fundus, an accurate operation and an easy operation are desired. In particular, it is desirable to insert a surgical instrument into the eye through a wound hole opened in the sclera, and operate the instrument around the hole position. In order to position the distal end of the surgical instrument in a fine portion of the fundus, an operation and control for simultaneously adjusting the angle of the multi-indirect arm are necessary, and a fine operation with the wrist and fingers is not easy. In addition, with the conventional support device, it is difficult to quickly move the direction and position of the distal end of the surgical instrument, and it is conceivable that accuracy decreases due to play between links and accumulation of insufficient rigidity when fixed.

  An object of the present invention is to provide an ophthalmic surgery support apparatus that can easily operate a surgical instrument and that can easily position the distal end of the surgical instrument with respect to an affected part with high accuracy.

  In order to solve the above problems, the present invention is characterized by having the following configuration.

(1) In an ophthalmic surgery support apparatus that positions a tip of a surgical instrument in a minute part in an eyeball and assists an operator to operate the surgical instrument.
An axial holding unit that holds the surgical instrument so as to be movable in the axial direction of the longitudinal axis of the surgical instrument, and the axial direction so that the surgical instrument can tilt two-dimensionally about a predetermined point O on the longitudinal axis. An inclination unit for holding the holding unit, the inclination unit,
A coarse tilt mechanism that is tiltable about the predetermined point O in order to roughly position the distal end of the surgical instrument that the surgeon tilts;
Coarse movement fixing means for fixing the inclination of the coarse movement inclination mechanism part;
A fine motion tilt mechanism portion that is tiltable together with the coarse motion tilt mechanism portion and to which the axial direction holding unit is attached, and is provided with a limiting mechanism that limits the tilt to a narrower range than the tilt of the coarse motion tilt mechanism portion. A fine-motion tilt mechanism that is switched to a narrow range of tilt limited by the limit mechanism when the tilt of the coarse tilt mechanism is fixed;
The tilting operation when the surgeon tilts the surgical instrument within the range of restriction by the limiting mechanism is more effective when the surgical instrument is tilted by the fine motion tilting mechanism than by the coarse tilting mechanism. It characterized by having a a resistance application means for applying a resistance to a heavy operation.
(2) In an ophthalmic surgery support apparatus that positions a tip of a surgical instrument in a fine portion in the eyeball and supports an operator to operate the surgical instrument,
An axial holding unit that holds the surgical instrument so as to be movable in the axial direction of the longitudinal axis of the surgical instrument, and the axial direction so that the surgical instrument can tilt two-dimensionally about a predetermined point O on the longitudinal axis. A tilt unit for holding a holding unit, the first tilt unit holding the axial holding unit so as to be tiltable about an axis of the first axis passing through the predetermined point O, and the first axis at the predetermined point O. A tilt unit having a second tilt unit that tiltably holds the first tilt unit about an axis of a second axis that intersects with the first tilt unit, wherein the first tilt unit and the second tilt unit are respectively A coarse motion rotating part having a large tiltable range of the surgical instrument around a fixed point O, coarse motion fixing means for fixing the rotation of the coarse motion rotating part, and a fine motion rotating part independent of the coarse motion rotating part The coarse rotation part A fine-motion rotating part in which the range in which the surgical instrument can be tilted is limited to an angle narrower than the rotatable angle of the coarse-motion rotating part, and the rotation of the fine-motion rotating part is fixed to the coarse-motion rotating part. A fine movement fixing means that is fixed independently from each other, and a resistance imparting a resistance for making the rotation of the fine movement rotation section heavy with respect to the rotation of the coarse movement rotation section when the operator tilts the surgical instrument. And means.
(3) In the ophthalmic surgery support apparatus according to (2), axial rotation holding means for holding the surgical instrument rotatably about the longitudinal axis and the axial movement of the surgical instrument by the axial holding unit are fixed. An axial movement fixing means, an axial rotation fixing means for fixing rotation around the axis of the surgical instrument by the axial rotation holding means, the coarse movement fixing means, the fine movement fixing means, the axial movement fixing means, and the axial movement fixing means. Each of the fixing means includes a fixed signal input means for inputting a signal to operate the fixing means, and a control means for controlling the operation of the fixing means based on the signal input. It has a brake mechanism using air pressure.
(4) In the ophthalmic surgery support apparatus according to (3), the signal input means includes a foot switch in which a plurality of switches are arranged, and is also used as a foot switch for another ophthalmic surgery apparatus placed in the operating room. It is characterized by that.

  According to the present invention, operation of a surgical instrument can be performed easily, and positioning of the surgical instrument tip with respect to an affected part can be easily performed with high accuracy.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a schematic configuration diagram of an entire ophthalmic surgery support apparatus according to the present invention. The surgery support apparatus 1 includes an extraocular movement unit 100 for first positioning the surgical instrument 10 outside the eye, an intraocular positioning unit 200 for assisting when operating the surgical instrument 10 in the eye, Is provided.

  The extraocular movement unit 100 moves the intraocular positioning unit 200 in the x-axis direction (left-right direction in FIG. 1), y-axis direction (direction perpendicular to the paper surface in FIG. 1), and z-axis direction (up-down direction in FIG. 1). And a mechanism for holding the position. The extraocular movement unit 100 of this embodiment includes an xyz fine adjustment unit 110 for finely adjusting the intraocular positioning unit 200 and an xyz rough adjustment unit 150 for coarsely adjusting the intraocular positioning unit 200. Prepare.

  The xyz fine adjustment unit 110 includes a base 112, an x-axis movement base 114 movable in the x-axis direction with respect to the base 112, an x-axis micrometer for adjusting the position of the x-axis movement base 114, and an x-axis A y-axis moving base 120 movable in the y-axis direction with respect to the moving base 114, a y-axis micrometer 122 for moving the y-axis moving base 120 in the y-axis direction, and a z-axis with respect to the y-axis moving base 120 The arm is movable in the axial direction, and is roughly constituted by an arm 124 that supports the intraocular positioning unit 200 and a z-axis micrometer 126 that moves the arm 124 in the z-axis direction.

  The xyz coarse adjustment unit 150 includes an arm 152 on which the xyz fine adjustment unit 110 is mounted, and a moving unit 154 that moves the arm 152 in the x, y, and z directions. The moving unit 154 can be configured by a known mechanism such as a sliding mechanism in each direction or a motor. In the case of a motor drive mechanism, it is possible to move by inputting a movement instruction signal with a joystick, and the xyz fine adjustment unit 110 can be held at a fixed position by stopping the motor. Moreover, when driving manually, the xyz fine adjustment unit 110 can be held at a fixed position by providing a brake mechanism.

  When positioning the intraocular positioning unit 200, the intraocular positioning unit 200 can be moved quickly by the coarse adjustment unit 150 and then finely adjusted by the fine adjustment unit 110 for positioning. It should be noted that the fine adjustment unit 110 and the coarse adjustment unit 150 can be integrally configured by making the drive speed of the motor constituting the coarse adjustment unit 150 variable.

  FIG. 2 is a diagram for explaining the configuration of the intraocular positioning unit 200. The intraocular positioning unit 200 includes a surgical instrument holding unit 300 that holds the surgical instrument 10, an X tilt unit 400 and a Y tilt unit 500 that tilt the surgical instrument 10 held by the holding unit 300 two-dimensionally, And a Z moving unit 600 to which the holding unit 300 is attached so as to be movable in the axial direction of the axis of the surgical instrument 10. The longitudinal axis of the surgical instrument 10 is taken as the Z axis. In FIG. 2, when the Z axis of the surgical instrument 10 is in the vertical direction, it is defined as the Z0 axis, and a predetermined point located a predetermined distance below the Z moving unit 600 on the Z axis is a tilt center point (operation point) O. And two axes orthogonal to each other on a plane orthogonal to the Z0 axis with the tilt center point O as a reference are defined as an X0 axis and a Y0 axis. The X tilt unit 400 and the Y tilt unit 500 constitute a tilt unit that holds the Z moving unit 600 so that the surgical instrument 10 can tilt two-dimensionally about the tilt center point O.

  FIG. 3 is a view of the intraocular positioning unit 200 in FIG. 2 when viewed from a direction (Y0 axis direction) orthogonal to the X0-Z0 plane including the X0 axis and the Z0 axis. The X tilt unit 400 holds the Y tilt unit 500 so as to be rotatable (tilted) around the X tilt axis XT passing through the tilt center point O. The X tilt axis XT is located on the X0-Z0 plane, and is arranged in a positional relationship tilted 30 degrees from the X0 axis (60 degrees from the Z0 axis) with respect to the center point O. The Y tilt unit 500 is attached to an arm 402 that is rotated about the X tilt axis XT.

  FIG. 4 is a view of the intraocular positioning unit 200 in FIG. 2 when viewed from a direction (X0 axis direction) orthogonal to the Y0-Z0 plane including the Y0 axis and the Z0 axis. The Y tilting unit 500 holds the surgical instrument holding unit 300 so as to be rotatable (tilted) around the Y tilt axis YT passing through the tilt center point O. The Y tilt axis YT is located on the Y0-Z0 plane, and when the Z axis of the surgical instrument 10 is positioned in the vertical direction (Z0 axis direction), it is 30 degrees (Z0 axis) from the Y0 axis with respect to the center point O. (60 degrees from). The Z moving unit 600 is attached to a block 602 that is rotated about the Y tilt axis YT.

  The rotation mechanism of the X tilt unit 400 will be described with reference to FIG. FIG. 5 is a cross-sectional view of the X tilt unit 400 taken along the X0-Z0 plane.

  The X fine movement shaft 404 is coaxial with the X tilt axis XT and is rotatably held in the housing 408 via bearings 405 and 406. The inside of the X fine movement shaft 404 is formed hollow with the X tilt axis XT being stopped. An arm 402 is fixed to the front end (center point O side) of the X fine movement shaft 404. A friction joint 410 is attached between the housing 408 and the X fine movement shaft 404. The friction joint 410 fixes / releases the X fine movement shaft 404 with respect to the housing 408 by tightening / loosening a pressure screw (not shown). The X fine movement shaft 404 is fixed by generating a strong frictional force by the friction joint 410. Tightening / loosening of the pressure screw is performed by a pneumatically driven rotary actuator 412 (see FIG. 2) attached outside the housing 408. Compressed air is supplied to the rotary actuator 412 from the compressed air supply pump 50 shown in FIG. 1 via a tube. Supply and decompression of compressed air are performed by pneumatic control of the solenoid valve 53 (see FIG. 1). The means for fixing the X fine movement shaft 404 is not limited to the friction joint 410 but may be other means using friction or the like.

  Further, behind the X fine movement shaft 404, a hollow X coarse movement shaft 420 is rotatably supported by the housing 424 via two bearings 421 and coaxially held by the X tilt axis XT. The X fine movement shaft 404 and the X coarse movement shaft 420 are configured independently. The rotatable range of the X coarse movement shaft 420 (the tiltable range of the surgical instrument 10) is relatively large, and the surgical instrument 10 can tilt more than 55 degrees (tilt angle to the right in FIG. 4) from the vertical state. Preferably there is. Furthermore, it is preferable that the surgical instrument 10 can be tilted ± 60 degrees or more from the vertical state to the left and right sides.

  The X coarse movement shaft 420 is fixed to the rotor 430 of the electromagnetic clutch 428 via a key 426. The armature 432 included in the electromagnetic clutch 428 presses the rotor 430 in a normal state, and is separated from the rotor 430 by electromagnetic force generated by energization. As a result, the X coarse movement shaft 420 is changed from the fixed state (brake state) by the pressing of the rotor 430 to the released state. The electromagnetic clutch 428 is connected to the control unit 20 (see FIG. 1). In FIG. 1, the control unit 20 operates the electromagnetic clutch 428 when a brake operation signal of the X coarse movement shaft 420 is input from the switch of the operation panel 30 or the foot switch 40.

  A flange 414 is attached to the rear end side of the X fine movement shaft 404 (the side where the X coarse movement shaft 420 is located). A flange 440 is also attached to the tip side of the X coarse movement shaft 420 (the side where the X fine movement shaft 404 is located). A hole 416 is formed in the flange 414, and a boss 442 that engages with the hole 416 is attached to the flange 440. The diameter of the hole 416 is larger than the diameter of the boss 442, and the gap between the hole 416 and the boss 442 is provided with a resistance to make the rotation of the X fine movement shaft 404 (inclination of the surgical instrument 10) heavy operation. A viscoelastic member 443 such as silicon resin is inserted. The hole 416 and the boss 442 limit the angle of rotation about the X tilt axis XT of the surgical instrument 10 to an angle narrower than the rotation angle of the X coarse movement axis 420, thereby roughly limiting the range in which the surgical instrument 10 can be tilted. It is used to switch to at least two stages of a dynamic range and a fine range. When the X fine movement shaft 404 is rotated around the X tilt axis XT while the X coarse movement shaft 420 is fixed, the flange 414 is also rotated and the viscoelastic member disposed in the gap between the boss 442 and the hole 416 is rotated. 443 is deformed. The flange 414 can move to a deformable range of the viscoelastic member 443. Therefore, when the X coarse movement shaft 420 is fixed by the electromagnetic clutch 428, the X fine movement shaft 404 can rotate only to a deformable range of the viscoelastic member 443 disposed in the gap between the boss 442 and the hole 416. In addition, the response to the external force (operation in which the surgeon tilts the surgical instrument 10) is also heavier than the case where the X coarse motion shaft 420 is not fixed due to the resistance of the elastic force of the viscoelastic member 443. . For this reason, the fine positioning of the distal end of the surgical instrument 10 tilted around the X tilt axis XT together with the X fine movement shaft 404 and the Y tilt unit 500 is facilitated. When the X fine movement shaft 404 is fixed by a friction joint 410 which is an X fine movement shaft brake independent of the fixation of the X coarse movement shaft 420 at a desired position (angle), the inclination of the surgical instrument 10 about the X inclination axis XT is as follows. It is completely fixed.

  Note that the movable range of the X fine movement shaft 404 is set within a range of ± 5 degrees with reference to the time when the X coarse movement shaft 420 is fixed as a range that allows a minute movement of the distal end of the surgical instrument 10. preferable. For example, when the distal end of the surgical instrument 10 is 25 mm away from the center point O (when the distal end of the surgical instrument 10 inserted into the eye is aligned with the fundus), the distal end of the surgical instrument 10 is ± 1.0 mm. In order to swing within the range, the X fine movement axis 404 is limited to be rotatable within a range of about ± 2.3 degrees. More preferably, the surgical instrument 10 is limited to be rotatable within a range of about ± 1.15 degrees so that the distal end of the surgical instrument 10 can swing within a range of ± 0.5 mm.

  Further, as a means for imparting resistance in order to make the rotation of the X fine movement shaft 404 (that is, the inclination of the surgical instrument 10) heavy, instead of using the viscoelastic member 443, a rotary damper is provided on the flange 440 side. A pinion shaft may be provided, and a spur gear as a damper guide meshing with the pinion shaft may be provided on the flange 414 side. Or it can also be set as the structure which applies resistance using the air pressure from the pump 50. FIG.

  6, 7 and 8 are diagrams for explaining the balance mechanism 450 around the X tilt axis XT of the X tilt unit 400, and FIG. 6 shows a view seen from the direction A in FIG. Shows a view seen from the B direction of FIG. 6, and FIG. 8 shows a view seen from the C direction of FIG.

  The arm 452 is attached to the flange 414 of the X fine movement shaft 404. The arm 452 extends in the same angular direction as the Y tilting unit 500 fixed to the arm 402 shown in FIGS. The arm 452 is rotated together with the X fine movement shaft 404. The block 456 to which the cam follower 454 shown in FIG. 8 is fixed is fixed to a long hole 453 (see FIG. 7) formed in the arm 452 with a screw so that the radial distance can be adjusted. Two linear motion guides 460 are fixed on a base 458 fixed to the housing 408. The moving block 462 moves along the linear motion guide 460 and constantly receives the moment load due to the gravity of the Y tilting unit 500 from the cam follower 454. Two constant load springs 464 are fixed on the base 458. The tip of the constant load spring 464 pulls the moving block 462, and the constant load spring 464 cancels the moment load applied to the moving block 462. The position of the long hole 453 for fixing the block 456 to the arm 452 is adjusted to balance the load.

  In FIG. 5, a shaft 480 serving as an alignment means for aligning the inclined center point O with the wound of the patient's eye is inserted into the hollow portion of the X fine movement shaft 404 and the hollow portion of the X coarse movement shaft 420. Is done. The tip of the shaft 480 is tapered. A stopper 481 is fixed to the rear of the shaft 480, and the length to the tip of the shaft 480 is adjusted in advance by the stopper 481 so that the tip of the shaft 480 coincides with the tilt center point O. Further, after the positioning is completed, an O-ring 482 made of an elastic member for retracting the shaft 480 and holding it in the hole of the arm 402 is attached near the tip of the shaft 480.

  FIG. 9 is a view for explaining the rotation mechanism of the Y tilt unit 500, and is a cross-sectional view of the Y tilt unit 500 taken along the plane Y0-Z0 in FIG. The Y fine movement shaft 502 is held by the housing 506 so as to be rotatable around the Y tilt axis YT by two bearings 504. Near the center of the Y fine movement shaft 502, a Y fine brake disk 508 is fixed. By pressing the Y fine brake disc 508 from both sides with the two pads 510a and 510b, the rotation of the Y fine adjustment shaft 502 is restrained. The two pads 510a and 510b are movable in a direction in which the Y fine brake disc 508 is pressed by rubber diaphragms 512a and 512b, respectively. When compressed air is supplied from the compressed air supply pump 50 through the tube, the diaphragms 512a and 512b are pushed out. When the compressed air supplied from the compressed air supply pump 50 is opened to the atmosphere or depressurized, the pads 510a and 510b are pulled back by the restoring force of the rubber diaphragms 512a and 512b. Compressed air supply and decompression (atmospheric release) are performed by controlling the positive pressure of the compressed air supply pump 50 with the electromagnetic valve 51. The potential valve 51 is performed in response to a switch signal from the operation panel 30 or the foot switch 40.

  Further, on the rear end side (the right side in FIG. 9) of the Y fine movement shaft 502, a Y coarse movement rotation member 513 is provided coaxially with the Y fine movement shaft 502 via two bearings 516. The Y fine movement shaft 502 and the Y coarse movement rotation member 513 are configured independently. The range in which the Y coarse motion can be rotated (the range in which the surgical instrument 10 can be tilted) is preferably such that the surgical instrument 10 can be tilted ± 45 degrees or more from the vertical state. Furthermore, it is preferable that the surgical instrument 10 can be tilted by ± 60 degrees or more from the vertical state. A Y coarse brake disc 514 independent of the Y fine brake disc 508 is fixed to the Y coarse rotary member 513. Further, a fixed pad 518a and a moving pad 518b are arranged so as to sandwich the Y coarse brake disc 514 from both sides. The fixed pad 518a is adjusted by the adjusting screw 520 so as to ensure a slight gap that does not come into contact when the Y coarse brake disc 514 rotates. Further, the moving pad 518b is disposed so as to be movable in a direction in which the brake disk 514 is pressed by the diaphragm 522. When compressed air is supplied from the compressed air supply pump 50 through the tube, the diaphragm 522 pushes out the moving pad 518b. When the moving pad 518b is pushed out, the brake disc 514 is elastically deformed in the direction of the fixed pad 518a, and is sandwiched and restrained between the fixed pad 518a and the moving pad 518b. When the positive pressure of the compressed air supply pump 50 is released to the atmosphere or reduced by the opening / closing control of the electromagnetic valve 52, the moving pad 518b is pulled back by the restoring force (or negative pressure control) of the rubber diaphragm 522, and the Y coarse brake disc 514 Is released. The brake operation of the Y coarse rotation member 513 is performed in response to an operation signal of the operation panel 30 or the switch of the foot switch 40.

  The Y tilting unit 500 is provided with a mechanism for limiting the rotation angle of the Y fine movement shaft 502 and a mechanism for imparting resistance to increase the rotation of the Y fine movement shaft 502. The structure is basically the same as that of the X tilt unit 400. That is, the flange 530 is fixed to the Y fine movement shaft 502, and the flange 540 is fixed to the tip side of the Y coarse movement rotation member 513. A hole 532 is formed in the flange 530, and a boss 542 that engages with the hole 532 is attached to the flange 540. The hole 532 and the boss 542 limit the angle of rotation about the Y tilt axis YT of the surgical instrument 10 to an angle narrower than the rotation angle of the Y coarse rotation member 513, so that the surgical instrument 10 can be tilted. It is used to switch between at least two stages of coarse movement range and fine movement range. The diameter of the hole 532 is larger than the diameter of the boss 542, and in the gap between the hole 532 and the boss 542, as a means for imparting resistance in order to make the rotation of the Y fine movement shaft 502 (inclination of the surgical instrument 10) a heavy operation, A viscoelastic member 534 such as silicon resin is inserted. Therefore, when the Y coarse movement rotating member 513 is fixed by the brake disk 514 or the like, the Y fine movement shaft 502 can rotate only within a deformable range of the viscoelastic member 534 in the gap between the boss 542 and the hole 532, The reaction also becomes a heavy operation (resistance is applied) by the viscoelastic member 534. For this reason, when only the Y fine movement shaft 502 is moved, accurate positioning can be easily performed. The movable range of the Y fine moving shaft 502 is set in the same manner as the movable range of the X fine moving shaft 404. That is, it is preferable that the movable range of the Y fine movement shaft 502 be within a range of ± 5 degrees with reference to the time when the Y coarse movement rotating member 513 is fixed. When the Y fine movement shaft 502 is braked, the rotation (tilt) of the surgical instrument 10 (holding unit 300) that can rotate about the Y tilt axis YT is completely fixed and positioned.

  A balance mechanism is provided between the Y fine movement shaft 502 and the Z movement unit 600. The balance mechanism includes a spring or the like that reduces a gravitational moment that acts when the surgical instrument 10 is tilted about the Y tilt axis YT. ing. This balance mechanism can be a mechanism similar to the balance mechanism 450 of the X tilt unit 400.

  FIG. 10 is a diagram for explaining the configuration of the Z moving unit 600. 10A is a view when the Z moving unit 600 is viewed from the side, FIG. 10B is a view when FIG. 10A is viewed from the D direction, and FIG. 10C is FIG. It is the figure which looked at (a) from E direction, FIG.10 (d) is FF sectional drawing of FIG.10 (b).

  The block 602 is attached to the Y fine movement shaft 502. A fixed base 604 extending in the Z-axis direction is fixed to the block 602. A Z fine movement block 610 is held on the fixed base 604 via a linear motion bearing 608 so as to be movable in the Z direction. A micrometer head 605 is attached to the upper end 604 a of the fixed base 604. Further, the Z fine movement block 610 is configured to be pressed against the micrometer head 605 side by a spring 616 provided between the fixed base 604 (a structure that is constantly biased upward). By operating the micrometer head 605, quantitative fine movement in the Z-axis direction of the Z fine movement block 610 becomes possible. The arrangement relationship between the micrometer head 605 and the spring 616 may be reversed upside down. That is, the Z fine movement block 610 is always urged downward by the spring 616, and the position at which the Z fine movement block 610 is moved downward (Z direction) is quantitatively adjusted by the micrometer head 605. In this case, the surgeon can pull the distal end of the surgical instrument 10 away from the affected part by operating the surgical instrument 10 by hand.

  A holding base 612 is fixed to the Z fine movement block 610. Further, a Z moving block 620 is held by a holding base 612 so as to be movable in the Z direction via a cross roller type linear motion shaft 621. The Z moving block 620 is suspended from the holding base 612 by a tension spring 623, and a downward load due to its own weight is reduced. In a holder 625 having a U-shaped cross section disposed on both sides of the Z moving block 620, a tube 626 that is inflated by air pressure is provided, and a Z pad 627 is formed on the U-shaped open surface from above. The Z pad 627 is pressed by a leaf spring 628. When compressed air is supplied to the tube 626 from the pump 50, the Z moving block 620 is sandwiched by the extruded Z pad 627 and restrained. The restraining operation of the Z moving block 620 is also performed in response to the switch signal of the operation panel 30 or the foot switch 40.

  FIG. 11 is a diagram illustrating the configuration of the holding unit 300. FIG. 11A is a side view of the holding unit 300 with the surgical instrument 10 attached thereto. FIG.11 (b) is GG sectional drawing of Fig.11 (a). FIG. 12 is a diagram for explaining an adapter 350 used when the surgical instrument 10 is held by the holding unit 300.

  Prior to the description of the holding unit 300, the structure of the adapter 350 will be described with reference to FIG. In FIG. 12, the adapter 350 is non-rotatably attached to the rear end of the surgical instrument 10. A flat surface 10 a is formed on the side surface of the rear end of the surgical instrument 10. An insertion hole that fits into the shape of the flat surface 10 a of the surgical instrument 10 is formed inside the adapter 350. Therefore, the adapter 350 can be easily inserted from the rear end side of the surgical instrument 10. When the adapter 350 is attached to the holding unit 300, a first rotating track portion 352a and a second rotating track portion 352b that are held by bearings 312 and 313 (see FIG. 11) on the holding unit 300 side are formed. A friction groove 354 to which the brake pad 315 is pressed is formed between the first rotation track portion 352a and the second rotation track portion 352b. The internal structure and length of the adapter 350 are prepared in accordance with the shape of the rear end of the surgical instrument 10.

  The structure of the holding unit 300 will be described with reference to FIG. The fixed base 302 is fixed to the Z moving block 620 shown in FIG. An instrument rear end holding arm 304 is attached from the upper end of the fixed base 302, and an instrument tip holding arm 306 is attached from the lower end of the fixed base 302. An insertion hole 307 having a conical surface for receiving the tapered small diameter portion 10b (see FIG. 12) of the surgical instrument 10 is formed at the distal end portion of the instrument distal end holding arm 306. The insertion hole 307 is preferably made of a material having a low frictional resistance in order to facilitate the rotation of the surgical instrument 10 around the Z axis. A sufficient space is provided between the fixed base 302, the instrument rear end holding arm 304, and the instrument tip holding arm 306 so that the operator can grasp the main body 10 c of the surgical instrument 10 by hand.

  The instrument rear end holding arm 304 is provided with a rear end holding portion 310 that rotatably holds an adapter 350 attached to the rear end of the surgical instrument 10. The rear end holding portion 310 includes three bearings 312 arranged at 120 ° intervals so as to rotatably hold the first rotation track portion 352a. The rear end holding part 310 includes a brake pad 315 that is pressed against the friction groove 354 on the adapter 350 side. The brake pad 315 is pressed against the friction groove 354 side by a cylinder rod 317 driven by compressed air supplied from the pump 50 through a solenoid valve 54, a tube, and a speed controller (not shown). Rotation around (θ axis rotation) is fixed. When the compressed air from the pump 50 and the reduced pressure (atmospheric release) are switched by the pneumatic control of the solenoid valve 54, the cylinder rod 317 moves and the brake pad 315 is pulled back, and the rotation of the surgical instrument 10 around the axis is fixed. Canceled.

  In order to adjust the fixing force and the response time, a speed controller (not shown) is arranged between the electromagnetic valve 54 and the brake unit including the cylinder rod 317 and the like.

Further, the rear end holding part 310 is supported by an adapter pressing plate 320 and a pressurizing plate 321 for preventing the adapter 350 from being detached. The adapter pressing plate 320 includes three bearings 313 arranged at 120 ° intervals so as to rotatably hold the second rotating track portion 352b. The adapter pressing plate 320 and the pressurizing plate 321 are integrated through a spring.
The adapter pressing plate 320 and the pressurizing plate 321 are pressed against the bearings 312 and 313 by applying an appropriate force in the direction of the instrument rear end holding arm 304 by the screw 322, thereby preventing an excessive load from acting on the bearings 312 and 313. When the screw 322 is loosened, the adapter pressing plate 320 and the pressurizing plate 321 are detached from the rear end holding portion 310. Thereby, the adapter 350 attached to the surgical instrument 10 can be attached to the rear end holding portion 310. After the adapter 350 is attached to the rear end holding portion 310, the adapter 350 can be held by the rear end holding portion 310 by covering the adapter pressing plate 320 and the pressurizing plate 321 again from above and tightening the screws 322. .

  In FIG. 1, the control unit 20 includes an operation panel 30 having a plurality of switches and a display, a foot switch 40 capable of inputting a plurality of operation signals, an xyz rough adjustment unit 150, and compressed air from a compressed air supply pump 50. Solenoid valves 51, 52, 53, 54 and the like for controlling supply / decompression are connected.

  Next, operation | movement of the surgery assistance apparatus 1 is demonstrated. During the operation, as shown in FIG. 13, the tilt center point O of the intraocular positioning unit 200 is positioned with respect to the wound hole EH (or the planned incision portion) incised in the cornea of the patient's eye with another surgical instrument for incision. In order to match, the xyz coarse adjustment unit 150 and the xyz fine adjustment unit 110 of the extraocular movement unit 100 are operated. The alignment is performed before the surgical instrument 10 is mounted on the holding unit 300. In order to align the tilt center point O with the wound hole EH, a shaft 480 as alignment means is inserted into the hollow portion of the X fine movement shaft 404 and the hollow portion of the X coarse movement shaft 420. The tip of the shaft 480 is positioned by a stopper 481 so as to coincide with the tilt center point O in advance. After the xyz rough adjustment unit 150 is operated and coarsely positioned, the xyz fine adjustment unit 110 is finely adjusted to make the tip of the shaft 480 coincide with the wound hole EH. Thereby, the inclination center point O can be aligned with the wound hole EH. Thereafter, the shaft 480 is pulled out of the hollow portions of the X fine movement shaft 404 and the X coarse movement shaft 420 or is retracted to a position where it does not get in the way, and is held by the O-ring 482 in the hole of the arm 402.

  The shaft 480 is held by using the X tilt unit 400 as an alignment unit of the tilt center point O with respect to the wound hole EH. However, the shaft 480 is attached to a dedicated holding mechanism separately provided in the intraocular positioning unit 200. You may make it hold | maintain. Further, instead of using the shaft 480, it is possible to optically align the tilt center point O with respect to the wound hole EH. For example, a projection optical system that projects a light beam from two directions toward the scleral hole EH is provided. The projections of the light beams from the two directions are adjusted so as to coincide at the tilt center point O. The tilt center point O can be aligned with the wound hole EH by projecting from two directions onto the scleral hole EH and moving the intraocular positioning unit 200 so that the projection positions of the two light beams coincide with each other. .

  When the inclination center point O is aligned with the wound hole EH, the operator attaches the surgical instrument 10 to the holding unit 300 as described above. When the surgical instrument 10 is mounted, the Z moving block 620 is moved upward and the brake of the Z moving block 620 is applied. After the surgical instrument 10 is mounted on the holding unit 300, the distal end of the surgical instrument 10 is moved toward the tilt center point O as shown in FIG. 14A by releasing the brake of the Z moving block 620. Can do. Then, as shown in FIG. 14B, the surgical instrument 10 is moved in the Z direction by hand, and the tip of the needle portion of the surgical instrument 10 is inserted into the eye. At the time of intraocular surgery, in addition to the surgical instrument 10, a perfusion cannula for supplying perfusate and a light guide for illuminating the inside of the eye are inserted into the eye, but the illustration is omitted here.

  The surgeon observes the patient's eyes with a microscope and operates the surgical instrument 10 to align the tip of the surgical instrument 10 with the fundus or the affected part in the eye. The surgical instrument 10 is held so as to be two-dimensionally tiltable around the tilt center point O by the X tilt unit 400 and the Y tilt unit 500 and is also movable in the Z-axis direction. At this time, since the tilt center point O is matched with the scleral wound EH, the distal end of the surgical instrument 10 can be easily moved within the eye without expanding the wound hole EH or damaging the sclera during tilt movement. Can be moved to. The reaction force from the eyeball to the surgical instrument 10 is also reduced, and the instrument tip can be easily positioned within the eye. Further, there is a balance mechanism for keeping the operation force low (allowing a light operation) for the operation axis affected by the gravity acting on the components such as the Y tilt unit 500 and the holding unit 300 when the surgical instrument 10 is moved. It is installed. For this reason, the surgeon can quickly and smoothly move the position and orientation of the distal end of the surgical instrument 10 performed manually.

  In addition, when aligning the front-end | tip of the surgical instrument 10 to an affected part, an operator observes the affected part in an eye from right above a patient's eye with a microscope. As shown in FIG. 14B, when the surgical instrument 10 is held obliquely and inserted into the eyeball, the holding mechanisms such as the X tilt unit 400 and the Y tilt unit 500 are within the observation field when viewed from directly above with a microscope. The position of the surgical instrument 10 can be easily confirmed.

  As the intraocular surgery, for example, a case where the distal end of the surgical instrument is aligned with a fine portion of the fundus, for example, a catheter is inserted into a fundus blood vessel of 0.1 to 0.2 mm will be described. While observing the affected part of the fundus with a microscope, the operator tilts the surgical instrument 10 two-dimensionally and moves it in the Z-axis direction so as to align the tip of the surgical instrument 10 with the target affected part. When the distal end of the surgical instrument 10 approaches the target site, a signal for applying the brakes of the X tilt coarse motion and the Y tilt coarse motion is input by the operation panel 30 or the foot switch 40. In response to this signal, the coarse movement brake mechanism of X inclination and Y inclination is driven by the control of the control unit 20, and the rotation of the X coarse movement shaft 420 and the Y coarse movement rotation member 513 is fixed, respectively. Thereby, the inclination of the surgical instrument 10 is restricted to a narrow range in which the X fine movement axis 404 and the Y fine movement axis 502 can rotate (that is, the XY movement range of the surgical instrument tip is switched to the fine adjustment range). At the same time, the movement of the tilting operation of the surgical instrument 10 becomes heavy (slow) by the resistance applying means such as the viscoelastic member, and the sensitive operation is suppressed. For this reason, the surgeon can easily perform a precise positioning operation. Note that the X tilt coarse motion and the Y tilt coarse motion can be selectively fixed.

  Further, according to the tilt range switching mechanism of the X tilt unit 400 and the Y tilt unit 500, after the surgical instrument 10 is tilted at an arbitrary angle, the brakes of the X tilt coarse motion and the Y tilt coarse motion are respectively applied. A narrow range of fine motion tilt is possible with the tilt angle at which the coarse brake is applied as the neutral position. That is, since the neutral position that enables fine movement tilt in a narrow range can be set to an arbitrary tilt angle, precise alignment can be performed more easily.

  When the distal end of the surgical instrument 10 can be aligned with the fundus blood vessel, the operator presses the switch on the operation panel 30 to activate the X fine movement axis brake and the Y fine movement brake to fix the inclination of the surgical instrument 10. The X fine movement axis brake and the Y fine movement brake can be selectively operated. In addition, the Z movement brake is also activated, and only movement with fine adjustment is possible for movement in the Z-axis direction. Further, when the surgical instrument 10 needs to be rotated about the θ axis, the surgical instrument 10 is manually rotated around the axis, and then a switch on the operation panel 30 is pressed to operate a brake for rotating the θ axis to fix the rotation. Thereafter, by operating the micrometer head 605, the distal end of the surgical instrument 10 can be finely adjusted and inserted into the fundus blood vessel. The position at which the distal end of the surgical instrument is inserted into the fundus blood vessel is difficult to observe with a microscope, but since the distal end of the surgical instrument can be quantitatively moved in the Z direction by the micrometer head 605, precise surgery can be performed. When the distal end of the surgical instrument 10 can be inserted into the fundus blood vessel, the catheter is inserted into a fine blood vessel by a predetermined operation such as a lever attached to the main body of the surgical instrument 10.

  The surgical instrument 10 can be replaced with a forceps, a scissors, a lever or the like. It can replace with the vitreous cutter for removing the vitreous body in the eye. In this case, what changed the shape of the adapter 350 according to the shape of the rear end part of the surgical instrument may be prepared. In addition, by setting the attachment position of the instrument rear end holding arm 304 to the fixed base 302 as a mechanism that can be adjusted in the Z direction, surgical instruments having different lengths can be replaced.

  Another example of the embodiment will be described. The alignment of the inclined center point O with respect to the wound hole EH can be performed as follows. The surgical instrument 10 is mounted on the holding unit 300 in advance, and the surgical instrument 10 is set to Z so that the distal end of the surgical instrument 10 coincides with the distal end of the shaft 480 through the X fine movement shaft 404 and the X coarse movement shaft 420. Move in the axial direction. Thereby, the forefront of the surgical instrument 10 can be matched with the tilt center point O. When the leading edge of the surgical instrument 10 coincides with the tilt center point O, compressed air is supplied from the pump 50 to fix the movement of the surgical instrument 10 in the Z-axis direction. Then, the intraocular positioning unit 200 may be moved by the xyz coarse adjustment unit 150 and the xyz fine adjustment unit 110 in order to align the leading edge of the surgical instrument 10 with the wound hole EH.

  Further, since the surgeon holds the surgical instrument 10 and other surgical instruments by hand at the time of surgery, it is preferable to use the foot switch 40 for the brake operation signal of each unit 400, 500, 600. When the foot switch 40 is used in the operating room, a foot switch for a microscope and a foot switch for a cataract operating device are placed in the operating room, and a dedicated foot switch for the operation supporting device 1 is provided separately from these. , Feet become complicated and unusable. As this measure, it is convenient to use the foot switch 40 also as a foot switch of another surgical apparatus.

  FIG. 15 is a configuration diagram in the case where the foot switch of another surgical apparatus is also used as the foot switch of the surgical operation support apparatus 1. In FIG. 15, the surgical apparatus 1000 is a cataract surgical apparatus. This apparatus 1000 amplifies and transmits ultrasonic vibrations to a tip attached to the tip of a handpiece, crushes and emulsifies a lens nucleus that becomes cloudy due to cataracts, and sucks and removes the perfusate supplied into the eye. Also in this apparatus 1000, a foot switch is generally used as an input of operation signals for supplying perfusate, sucking waste liquid in the eye, and ultrasonic vibration. The foot switch 40 is provided at the center, and is provided on the left and right sides of the first switch 41, the first switch 41, and the four switches at the upper corners of the foot switch housing. The fourth switch 44, the fifth switch 45, the sixth switch 46, and the seventh switch 47 are provided. In the cataract surgery device 1000, these seven switches are assigned for supplying perfusion fluid, sucking waste fluid in the eye, and inputting operation signals of ultrasonic vibration. When the foot switch 40 is used as the surgery support device 1, the signal switching unit 21 switches the connection of the foot switch 40 to the control unit 20 of the surgery support device 1.

  For example, the seven switches of the foot switch 40 are assigned as follows. Each time the switch 46 is pressed, an X-gradient coarse brake signal, a fine brake signal, and a brake release signal are input. Every time the switch 44 is pressed, a coarse brake signal, a fine brake signal, and a brake release signal of Y inclination are input. Each time the switch 47 is pressed, a brake signal in the Z direction and a brake release signal are input. Each time the switch 45 is pressed, a θ-axis rotation brake and a brake release signal are input. When the switch 42 is pressed, a release signal for all brakes is input. Every time the switch 43 is pressed, the total coarse brake signal and its release signal are input. Every time the switch 41 is pressed, a total fine brake signal and its release signal are input. By combining the foot switch 40 with that of another surgical device, the trouble of replacing the foot switch 40 and the problem of space are eliminated, which is particularly convenient in ophthalmic surgery.

  In the above embodiment, an example in which an operator directly operates with the surgical instrument 10 has been described. However, the fine operations of the X coarse movement shaft 420, the Y fine movement shaft 502, and the micrometer head 605 are independently motorized. If comprised, the fine positioning in which it is difficult for an operator to directly operate the surgical instrument 10 can be further improved in accuracy.

1 is a schematic configuration diagram of an entire ophthalmic surgery support apparatus according to the present invention. It is a figure explaining the structure of the intraocular positioning unit. It is a figure when the intraocular positioning unit of FIG. 2 is seen from a direction (Y axis direction) orthogonal to the XZ plane including the X axis and the Z axis. It is a figure when the intraocular positioning unit of FIG. 2 is seen from a direction (X axis direction) orthogonal to a YZ plane including the Y axis and the Z axis. It is sectional drawing when a X inclination unit is cut | disconnected by XZ plane. It is a figure explaining the balance mechanism of X inclination unit. It is a figure explaining the balance mechanism of X inclination unit. It is a figure explaining the balance mechanism of X inclination unit. It is sectional drawing when a Y inclination unit is cut | disconnected by the YZ plane of FIG. It is a figure explaining the structure of Z movement unit. FIG. 6 is a diagram illustrating a configuration of a holding unit 300. It is a figure explaining the adapter for making a holding unit hold | maintain a surgical instrument. It is a figure explaining alignment of the inclination center point with respect to the wound hole incised by the cornea. It is a figure explaining operation | movement at the time of an operation. It is a block diagram in the case of using also the foot switch of another surgery apparatus as a foot switch of a surgery assistance apparatus.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Surgical instrument 20 Control unit 40 Foot switch 50 Compressed air supply pump 100 Extraocular movement unit 200 Intraocular positioning unit 300 Surgical instrument holding unit 400 X tilt unit 404 X fine movement axis 410 Friction joint 420 X coarse movement axis 428 Electromagnetic clutch 443 534 Viscoelastic member 480 Shaft 500 Y tilting unit 502 Y fine moving shaft 508 Y fine moving brake disc 513 Y coarse moving rotating member 514 Y coarse moving brake disc 600 Z moving unit 1000 Surgical device

Claims (4)

In an ophthalmic surgery support apparatus that positions the tip of a surgical instrument in a fine part in the eyeball and supports the surgeon to operate the surgical instrument,
An axial holding unit that holds the surgical instrument so as to be movable in the axial direction of the longitudinal axis of the surgical instrument, and the axial direction so that the surgical instrument can tilt two-dimensionally about a predetermined point O on the longitudinal axis. An inclination unit for holding the holding unit, the inclination unit,
A coarse tilt mechanism that is tiltable about the predetermined point O in order to roughly position the distal end of the surgical instrument that the surgeon tilts;
Coarse movement fixing means for fixing the inclination of the coarse movement inclination mechanism part;
A fine motion tilt mechanism portion that is tiltable together with the coarse motion tilt mechanism portion and to which the axial direction holding unit is attached, and is provided with a limiting mechanism that limits the tilt to a narrower range than the tilt of the coarse motion tilt mechanism portion. A fine-motion tilt mechanism that is switched to a narrow range of tilt limited by the limit mechanism when the tilt of the coarse tilt mechanism is fixed;
The tilting operation when the surgeon tilts the surgical instrument within the range of restriction by the limiting mechanism is more effective when the surgical instrument is tilted by the fine motion tilting mechanism than by the coarse tilting mechanism. An ophthalmic surgery support apparatus , comprising: a resistance applying unit configured to apply resistance for a heavy operation. In an ophthalmic surgery support apparatus that positions the tip of a surgical instrument in a fine part in the eyeball and supports the surgeon to operate the surgical instrument,
An axial holding unit that holds the surgical instrument movably in the axial direction of the longitudinal axis of the surgical instrument;
A surgical instrument is a tilting unit that holds the axial holding unit so as to be tiltable two-dimensionally about a predetermined point O on the longitudinal axis, and about a first axis passing through the predetermined point O A first tilt unit that tiltably holds the axial holding unit, and a second tilt that tiltably holds the first tilt unit about an axis of a second axis that intersects the first axis at the predetermined point O. An inclination unit having a unit,
The first tilting unit and the second tilting unit each have a coarse motion rotating part having a large tiltable range of the surgical instrument around the predetermined point O, and a coarse motion that fixes rotation of the coarse motion rotating part. A fine movement rotation part independent of the fixing means and the coarse movement rotation part, wherein the range in which the surgical instrument can be tilted when the coarse movement rotation part is fixed is greater than the rotatable angle of the coarse movement rotation part. Fine movement rotating part limited to a narrow angle, fine movement fixing means for fixing the rotation of the fine movement rotating part independently of the fixing of the coarse movement rotating part, and the coarse movement rotation when the operator tilts the surgical instrument An ophthalmic surgery support device, comprising: a resistance applying unit configured to apply resistance for causing the rotation of the fine movement rotating unit to be a heavy operation with respect to the rotation of the unit. 3. The ophthalmic surgery support apparatus according to claim 2, wherein axial rotation holding means for holding the surgical instrument so as to be rotatable about the longitudinal axis and axial movement of the surgical instrument by the axial holding unit are fixed. A fixing means, an axial fixing means for fixing rotation around the axis of the surgical instrument by the axial rotation holding means, and each fixing means of the coarse movement fixing means, fine movement fixing means, axial movement fixing means and axial rotation fixing means Fixed signal input means for inputting a signal for operating the control means, and control means for controlling the operation of each of the fixing means based on the signal input, wherein each of the fixing means uses air pressure sent from a pump. An ophthalmic surgery support apparatus, characterized by having a brake mechanism. 4. The ophthalmic surgery support apparatus according to claim 3, wherein the signal input means includes a foot switch in which a plurality of switches are arranged and is also used as a foot switch for another ophthalmic surgery apparatus placed in an operating room. Ophthalmic surgery support device characterized by the above.

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